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Thapelo M

1 reviews | Active since Aug 2018

20 Feb 2020, 14:39

Dom't use discovery if you are on chronic meds!!!

So last year l joined discovery medical scheme and they did not want to cover my son's full epileptic medication. At the time we moved over he was using epilim, trileptal and keppra. With the eplim they approved a generic nalvapro, with trileptal they approved a generic mylan- oxcarbazepine (which we struggled to find at pharmacies and made my son ****l and look like a vegetable) with the keppra they said no cover whatsoever as it is not on their fomulary list! I had to buy the medication cash. All this medicines where covered on the PMB of my previous medical aid Camaf although it was not on their formulary list as Camaf understood that they cant just mess with a chronic patient's medication and approved to cover his meds. I was only paying R2200 with Camaf and was on 1 of their lowest bracket plans (network choice), with discovery l was paying well over R5500 a month and they couldn't give a damn regardles of the many motivations we sent from his neurologist. So l decided to move to another plan which l pay R7200 on so they can cover his meds. I called discovery to confirm if they are not going to tell us about the formulary list on this plan and they said they wont, as long as its a PMB condition, the medication will be covered regardless of the type. Beacuse he had gotten used to using the mylan-Oxcarbazepine we continued with it this year. On the 6th of Jan I sent the new script to discovery med-express and they kept on calling saying they dont have stock of the very medication they made my son switch to. We only got the medication on the 20th of Jan after my son had run out of medication and was having seizures. So again now in feb l submited a script on the 13th and now they called to ask if they can give me trileptal instead (his original medication) as they dont have stock of the mylan.. I accepted this as my son was running out. To discovery the fact that the keep on changing my son's meds is no issue at all. Its business as usual!! never mind the impact it has on my child. To my suprise when l viewed the claim history, they claimed from the day to day medical savings this month and not from the PMB even after they assured me that regardless if the medication as long as l still have PMB cover they will pay from PMB!! Can someone from discovery just send me a detailed email explaining to me what all this nonsense is about?? I have really had it and its time to go to the mdecial ombuds now.

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Replies (2)
Discovery Health
Discovery Health's reply20 Feb 2020, 17:39
Official
Dear Thapelo Mogashoa

We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.

Regards
Discovery Health Servicing Team 
Discovery Health
Discovery Health's reply24 Feb 2020, 15:28
Official
Dear Thapelo M

We have been in touch with you to answer your comments.

Regards
 Discovery Health Servicing Team